Work process VS Data process: The same data does NOT mean the

same work processes

Ali Besiso Clinical Analyst - iCIMS

Email: ali@icims.com.au

Website: www.icims.com.au LinkedIn: http://www.linkedin.com/pub/ali-besiso/75/716/215

Brief CV

• B. Health Sciences (University of Sydney)

• M.H.I (University of Sydney)

• Research – Clinical Information System (CIS) design & user-testing

• Clinical Analyst @ iCIMS – multiple projects designing clinical systems with clinical teams mostly in ED & Oncology in NSW & Victoria

Overview

• A new approach: A design framework to reflect clinical work processes into your Clinical Information System

• Carrying out a workflow analysis in the clinical setting and achieving the desired workflow

• Workflow processes VS data processes • Workarounds • Practical examples on electronic process

mapping in different settings • Issues, outcomes and benefits

Key Projects

Projects including major Workflow Analysis & Re-design:

• CIS Design for ED in NSW

• CIS Design for Gynae-Oncology & Breast Cancer in VIC

• Oncology Multidisciplinary Meetings (MDMs)

… on Clinical IT Delivery

“the strategy was flawless, but

I couldn’t get anything done”

Mike Bracken (2013). On Strategy: The strategy is delivery. Again. (http://mikebracken.com/blog/the-strategy-is-delivery-again/)

Discovering the Workflow

Quotes:

• “This is how we were taught to do it”

• “It just has to be done this way”

• “No one ever asks about that”

• “We just do it because it needs to be done, but then we do this for our own work…”

• “We just go back and complete it later”

… a different approach, Clinical Team Led Design (CTLD)?

• Utilising a new methodology involving our IT technology to iteratively and continuously design & revise clinical work processes

• A collaborative approach between the clinical team (CTLD) and clinical process analysts that identifies the detailed work processes that even the clinicians may not be consciously aware of

• Then formally reflect them in their own Clinical Information System (CIS)

Key Concepts of the Approach (4E)

• Clinical teams of the same speciality do not necessarily want to capture different data, but rather the same data in different work processes and contexts.

• It is critical for the efficiency of clinical information systems to be designed to match the clinical workflow of that specific user community.

• Clinical work practice is in continuous evolution so as to adapt effectively, efficiently & economically (4E).

iCIMS Design Framework

Define all roles & scope of users (staff) Identify tasks Map tasks to roles Identify current work processes (paper/system) by

role/location “Current Workflow” Identify the data processes “Data Flow” Identifying pain areas, inefficiencies, workarounds, &

Desirables: “Desired Workflow” Baseline Testing & Evaluation ALL of the above take place around an iterative process

of “Design, Adapt & Test” using a Design Tool

iCIMS Perpetual Design Framework

Video: Design Process

Workflow VS Dataflow

“In our work on process design, we think of usability as the screen widgets and screen layout (typical human-technology interaction issues) ….”

“Then there is workflow or process flow,

where the processes of the staff are mapped to a system design that assists the

staff in doing their work with patients.”

“there is also data flow, the movement of data from the screen on which it is collected to the screens where it is re-used.”

www.icims.com.au

Workflow Process VS Dataflow Process

• Workflow process: a series of tasks in pathway sequences.

• Dataflow process: The content you record for one task AND carry across from to other tasks

• Both process types interact highly, but still maintain autonomy

Example

• Workflow Process: 1. Register a patient 2. Record their Incoming Referral 3. Assign them to an MDM review

• Dataflow Process: 1. Patient demographics captured in registration 2. Auto-filled into their incoming referral + data

entry of presenting problems 3. Fields from step 1 & 2 to auto-fill into their

MDM

Workflow Process VS Workaround

• Sometimes a very fine line

• When a workaround is practised long enough, it is subconsciously treated as a normal work process

• Example: Completing an electronic form on the system, then printing it to continue writing additional content on regular basis

Use Case 1: Gynae-Oncology MDM

Use Case 1 (Cont’d) • Investigations/Diagnostic Tests Hospital X:

Hospital Y:

Use Case 1 (Cont’d)

Hospital X:

Hospital Y:

• Not required …. But why?

Work process, staff size, structure

Use Case 2: Diagnosis/Surgery Findings

• Hospital X

Use Case 2 (Cont’d) • Hospital Y

Use Case 2 (Cont’d) Hospital Y:

Advantages

• Increase Intuitiveness

• Higher Trainability

• Lower Cognitive Load

• Increase staff efficiency

• Provides platform for Continuous Process Improvement & Incremental Development

Risks/Challenges

• Clinical team have to make time to be actively involved which is not always feasible

• Conflicts/Disagreements (between key members of design team)

• Scope Creep

Conclusion

• The detailed workflow of the user-community in their own setting should be the basis of their CIS-design led by them

• Systems should be designed to supply “not-quite-enough” functionality and then be “readily-expandable” – Minimise Cognitive Load

• When clinicians are confident they know what computerisation will be of the "next-best-benefit“ – Incremental Development

Questions

Thank You

E-mail: ali@icims.com.au

W: www.icims.com.au